Anatomical Description of the Presence and Variability of the Digital Manica Flexoria in the Equine Digital Flexor Tendon Sheath

Newly described anatomical opening on forelimb tendon in the artiodactyls and its relation to knee clicks

To understand which morphological/anatomical parts may be responsible in artiodactyl ungulates for the clicking sound made when moving, this research focuses on the forelimb tendon apparatus where an undescribed opening in the fibrous cuff (manica flexoria), called hereafter for its shape as an “oval window” in the manica flexoria (OWMF), was detected. This oval window was found in 24 of the 25 species of four families (Camelidae, Giraffidae, Cervidae, and Bovidae) evaluated; the exception being in Bos taurus taurus (Domestic cattle). The length and width of the OWMF enabled correct species discrimination between the majority of species, but remained conservative intraspecifically, as it did not differ between the left and right side of the forelimb, third and fourth digits, or between sexes. When evaluating the shape of OWMF in individual species, and measuring its length and width, 18 out of the 24 species investigated had this window as an oval shape, the remaining 25% of species exhibited more oval-oblong shapes with either proximal or distal asymmetry. The function of the OWMF in the thoracic autopodium of most ruminant even-toed ungulates is not yet fully understood. Its most likely function is to help balance the pressure inside the ligament cuff and reduce the friction of the touching surfaces of the muscle tendons—thus facilitating the movement of the digits when walking. None of the absolute or relative OWMF parameters fit exclusively with the occurrence and distribution of knee-clicks produced by some bovids and cervids during movement, so the mechanism responsible for this sound remains cryptic from the present anatomical perspective.

An anatomical and histological study of the equine proximal manica flexoria

Objectives: The main aim was to describe the gross and histological appearance of the equine manica flexoria and to identify any differences between the forelimbs and hind-limbs. An additional aim was to relate the findings to diagnostic and surgical anatomy of the manica flexoria.

Methods: Measurements of the manica flex-oria were made on cadaveric limbs from horses free from pathology within the digital flexor tendon sheath. Histological sections, stained with haematoxylin and eosin and alcian- periodic acid schiff, were evaluated based on three micro-anatomical zones from dorsal to palmar or plantar. The prevalent tenocyte morphology, number, and distribution of blood vessels and nerves were described in each zone. Forelimb and hindlimb measurements were compared using a Students T-test.

Results: Proximally, the manica flexoria attaches to the digital flexor tendon sheath via a reflection of areolar tissue. The fibrous manica flexoria is longer in the forelimb (32.0 ± 4.2 mm) than the hindlimb (29.4 ± 3.8 mm) (p = 0.04), with the areolar portion longer in the hindlimb (22.9 ± 5.3 mm) compared to the forelimb (16.7 ± 4.3 mm) limb (p = 0.0005). Histologically, degenerate blood vessels were prevalent in the palmar/ plantar regions and were associated with chondrocyte-like tenocytes, indicative of fibrocartilagenous metaplasia.

Clinical significance: The study has provided a detailed anatomical description of the manica flexoria relevant for interpretation of diagnostic and surgical evaluation. Fibrocartilaginous metaplasia occurs on the palmar/plantar surfaces of the manica flex-oria.